阵发性房颤患者冠状静脉窦电图特征与心房颤动射频导管消融术后复发的关系  

The relationship between the characteristics of coronary sinus electrograms and the recurrence of atrial fibrillation after radiofrequency ablation in paroxysmal atrial fibrillation patients

作　　者：吴观军 王成[1] 孙秀华[1] 屈百鸣[1] WU Guanjun;WANG Cheng;SUN Xiuhua;QU Baiming(Department of Cardiology,Zhejiang Provincial People's Hospital,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)心内科,杭州310014

出　　处：《心电与循环》2020年第6期571-575,580,共6页Journal of Electrocardiology and Circulation

摘　　要：目的探讨阵发性房颤(PAF)患者冠状静脉窦(CS)电图特征与心房颤动射频导管消融术(下称消融术)后复发的关系。方法选取2015年1月至2017年12月在浙江省人民医院接受电生理检查和消融术的成人PAF患者113例为观察组,同期接受电生理检查和消融术的室上性心动过速患者155例为对照组,比较两组患者CS激动传导时间、激动顺序及影响因素,分析CS电图特征与消融术后预后的关系。结果CS激动传导时间观察组明显大于对照组(P<0.05)。两组间CS激动顺序比较,差异有统计学意义(P<0.05)。观察组1型CS激动顺序患者明显多于2、3型患者(均P<0.05)。CS激动传导时间1型患者明显大于2、3型患者(均P<0.05)。左心房内径与CS激动顺序和时间相关(均P<0.05),左心室射血分数与CS激动顺序相关(P<0.05)。术后随访12个月期间心房颤动(AF)复发23例,其中20例为1型CS激动顺序者。CS激动传导时间是影响AF复发的因素(OR=1.082,95%CI:1.031~1.136,P<0.05)。结论CS电图可反映心房电重构,显著的CS右向左激动顺序和传导时间增大与PAF消融术后复发风险有关。Objective To explore the relationship between features of coronary sinus(CS)electrograms and the recurrence of atrial fibrillation(AF)in paroxysmal AF patients after radiofrequency ablation.Methods One hundred and thirteen patients with paroxysmal AF and underwent electrophysiological test and radiofrequency ablation were enrolled from January 2015 to December 2017 in Zhejiang Provincial People's Hospital.One hundred and fifty-seven patients with supraventricular tachycardia(SVT)were selected as control group.The conduction time in CS,activation sequence and influencing factors were compared between the two groups.The relationship between the features of CS electrograms and the outcome after procedure was analyzed.Results The conduction time in CS was significantly longer in AF group than in SVT group(P<0.05).Activation sequence was significantly different between the two groups.The number of patients with type 1 activation sequence was significantly larger than that with type 2 and type 3 in AF group.The conduction time was significantly longer in type 1 than in type 2 and 3(all P<0.05).Left atrial diameter was significantly related to CS activation sequence and conduction time(all P<0.05).Left ventricular ejection fraction was significantly related to CS active sequence(P<0.05).AF recurred in 23 patients,of them,20 patients had type 1 activation sequence,during 12 months follow-up.CS conduction time was a factor influencing recurrence of AF(OR=1.082,95%CI:1.031-1.136,P<0.05).Conclusion CS electrogram may reflect atrial remodeling.CS activation sequence from right-to-left and conduction time increase are related to the risk of AF recurrence.

关 键 词：阵发性房颤 冠状静脉窦电图 射频消融 

分 类 号：R541.75[医药卫生—心血管疾病]